Organization
BOISE BASIN INFERTILITY & GYNECOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP M KRUEGER (PRESIDENT)
(208) 345-2006
Entity
Organization
Contact information
Practice address
811 N 6TH ST, BOISE, ID 83702-5545
(208) 345-2006
(208) 345-1408
Mailing address
811 N 6TH ST, BOISE, ID 83702-5545
(208) 345-2006
(208) 345-1408
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M-3549
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004456
BLUE SHIELD
ID
05
—
002515100
—
ID
05
—
002515101
—
ID
05
—
002515102
—
ID
01
—
DK093
BLUE CROSS
ID
Enumeration date
10/05/2006
Last updated
05/15/2008
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